Abstract
Section 136 of the Mental Health Act (1983) is a highly controversial police power, often used as suicide prevention, which enables the detention of a person who appears mentally disordered and in need of immediate care or control. Legislative change in 2017 appears unlikely to have resolved widespread concerns over the unsustainably high national rates of use. Understanding why some individuals are detained repeatedly is therefore vital if Section 136 numbers are to be lowered.Mixed-method research combined three data streams:
• Narrative interviews of participants with lived experience of recurrent suicidal crises and multiple detentions, which were jointly analysed with advisors who identified as having complex mental health needs
• A dataset of over 500 repeat detentions in Sussex
• A national police survey and further data from neighbouring areas
A realist-informed approach revealed how recurrent detention is triggered by a chain of interrelated factors. Nationally, the phenomenon is widely recognised and appears to constitute a third of Section 136 use. Most recurrent detentions in Sussex were characterised by slightly more men than women being detained twice, however a small but stark proportion represented the police intervening in the frequent suicide attempts of a few individuals, who were almost exclusively women. Most in this high frequency repeat group had received diagnoses of borderline or emotionally unstable personality disorder. The lived experience accounts described how the impact of unresolved trauma could be exacerbated by the disempowering medicalised approaches employed by mental health services. An unmanageable sense of hopelessness was recurrently provoked by the perception that these circumstances could not be changed. When this despair became overwhelming the police were forced to contain the resulting suicidal crises, fulfilling the position of always-available protector. However for some individuals, a multilateral trauma-informed approach had disrupted the cycle.
Repeated detention can thus be viewed as a lens through which to identify some of the most vulnerable people, who have found themselves experiencing frequent suicidal distress through serial societal disregard. This study makes a direct contribution to understanding this neglected area of research from a psychosocial perspective. The implications for practice and social policy are that consistent and empathetic support structures are necessary to enable individuals to develop stable, trusting relationships and a belief in having a future. This work also contributes to the ongoing debates regarding the limitations of the biomedical model of mental health care.
| Date of Award | Jun 2019 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Gillian Bendelow (Supervisor), Phil Haynes (Supervisor) & Julia Stroud (Supervisor) |